Provider Demographics
NPI:1801124052
Name:ANGELO J. LEONI, M.D., A MEDICAL CORP
Entity type:Organization
Organization Name:ANGELO J. LEONI, M.D., A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-762-4583
Mailing Address - Street 1:1116 B ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4054
Mailing Address - Country:US
Mailing Address - Phone:707-762-4583
Mailing Address - Fax:707-762-2145
Practice Address - Street 1:1116 B ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4054
Practice Address - Country:US
Practice Address - Phone:707-762-4583
Practice Address - Fax:707-762-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G1500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A55396Medicare UPIN